s*********e
发帖数: 77 | 1 发信人: LYXY (春困秋乏夏打盹*睡不够的冬三月), 信区: Medicine
标 题: 请帮忙！！再生障碍性贫血（Aplastic Anemia）
发信站: Unknown Space - 未名空间 (Fri Mar 25 21:07:00 2005) WWW-POST
我是学生，偶然因一次腹痛，医生给order
血常规（CBC）. 发现全血细胞减少（红细胞
，白细胞，血小板均减少）最近一次检查white: 1.4k/cu mm（4.4-11.0）, red:
2.64m/cu mm(3.65-5.10), platelet: 37k/cu mm(150-400).
骨髓穿刺和活检发现只有5%-10%。
医生初步诊断为再障。建议作骨髓移植。但是费用太高而且不一定有配型。
这版上有没有人曾经见过此类病人或者听说过。他们的治疗方法？
谁能提供消息，回站内信箱即可。
万分感谢！
发信人: GreaterWuhan (刘老教授坐堂), 信区: Medicine
标 题: Re: 请帮忙！！再生障碍性贫血（Aplastic Anemia）
发信站: Unknown Space - 未名 |
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w*l
发帖数: 43 | 2 aplastic - hypocellular marrow, often only fat cells/ 'dry tap' when do
marrow aspirate/ most likely no splenomegaly/reticulocytopenia/mucocutaneous
bact. infect./abnormal bleeding;
primary myelofibrosis - hallmark is oblitertive marrow fibrosis //
extramedullary hematopoisis eg spllen or liver - but disordered/immature RBC
&WBC in circulation/ 'teardrop' RBC/ hyperuricemia/ may transform to AML. |
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w*l
发帖数: 43 | 3 aplastic - hypocellular marrow, often only fat cells/ 'dry tap' when do
marrow aspirate/ most likely no splenomegaly/reticulocytopenia/mucocutaneous
bact. infect./abnormal bleeding;
primary myelofibrosis - hallmark is oblitertive marrow fibrosis //
extramedullary hematopoisis eg spllen or liver - but disordered/immature RBC
&WBC in circulation/ 'teardrop' RBC/ hyperuricemia/ may transform to AML. |
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f******I
发帖数: 769 | 4
么？
aplastic anemia is a type of marrow failure, bone marrow is where the blood
is produced, so patient would have low white cell, low red cell, and low
platelet count, and respectively patient would be vunerable to get
infections, fatigue, and easy bleeding;
it is diagnosed by bone marrow exam, depends on the severity of how low the
marrow cellularity is, if it's severe aplastic anemia, most of them die
within a year if not treated, and also older the patient's age worse the
prognosis,
sometime |
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W********r
发帖数: 158 | 5 Aplastic anemia has mild, moderate and severe. A young person with the
diagnosis of AA, several genetic tests are usually sent out to rule out
congenital bone marrow failure syndrome. Mild and moderate AA, supportive
therapy is enough. For severe aplastic anemia, if there is matched sibling
donor, the treatment of choice is bone marrow transplant. If there is no
match sibling donor, the treatment of choice will be cyclosporin and ATG. |
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k******u
发帖数: 3416 | 6 医生几次见到我直接说sorry了，血小板连续几周已经降到令人发指的程度；
（140-420是正常值，50以下是危险警戒，我现在30，而且每周往下降10个单位。呜呜
呜）
怀疑我是ITP甚至Aplastic Anemia。
今天正式开始treatment，吃激素升血小板，如果没效果就得做bone marrow确诊
Aplastic Anemia，心情down到底。
广泛求祝福求祷告！
呜呜呜呜~~~
（更新）
谢谢大家的祝福，真羡慕那些怀孕到生都没出过什么岔子的妈妈们~
我身边就有几个~
从怀孕到现在，宝宝和自己一直状况不断，心灰意冷了都要~
不过还好医生说单纯血小板低对宝宝没有严重的影响，就是低成这样我自己很危险。
唉，现在只要宝宝没事，我就有点信心好好治疗了。。。呜呜呜 |
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M*******1
发帖数: 467 | 7 Eye dropsIn the West, chloramphenicol is still widely used in topical
preparations (ointments and eye drops) for the treatment of bacterial
conjunctivitis. Isolated cases report of aplastic anaemia following
chloramphenicol eyedrops exist, but the risk is estimated to be less than 1
in 224,716 prescriptions.[9] Note. http://www.patient.co.uk/showdoc/40025037/ suggests that the link between chloramphenicol eye drops and aplastic anemia is "not well founded". |
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d*******e
发帖数: 89 | 8 E?
aplastic anemia---peripheral pancytopenia and marrow hypoplasia, and mild
macrocytosis is observed in association with stress erythropoiesis and an
elevated fetal hemoglobin levels.
Histologic findings of aplastic anemia include hypocellular bone marrow with
fatty replacement and relatively increased nonhematopoietic elements, such
as plasma cells and mast cells. |
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e****0
发帖数: 678 | 9 • leukemia
ALL AML CLL
child adult elderly
BM lymphoblasts 25%myeloblasts
lab Lymphocyte 5000, mature-appearing cells
• Osgood-schlatters disease
Adolescent male athletes
Traction apophysitis—quadriceps tendon put the traction on the
apophysis of the tibial tubercle where patellar tendon inserts.
A firm mass =heterotopic bone formation
Pain can be reproduced by extending the kne... 阅读全帖 |
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C*I
发帖数: 4736 | 10 别扯蛋了护士！
四环素，Chloramphenicol，人吃的美国于1991年就停止生产了。 ！
Manufacture of oral chloramphenicol in the U.S. stopped in 1991, because the
vast majority of chloramphenicol-associated cases of aplastic anaemia are
associated with the oral preparation. No oral formulation of chloramphenicol
is now available in the U.S.
实在不明白你这美国护士是怎么做的？ 看来你也是个瞎扯蛋的蒙古大夫。
好好带上老花镜，把字典拿在手里看wiki了，
http://en.wikipedia.org/wiki/Chloramphenicol
a
,
number |
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t**x
发帖数: 20965 | 11 Here's a (partial) list of all the pre-existing conditions the GOP bill may
not cover
感觉常见病都包了
Acne
Acromegaly
AIDS or ARC
Alzheimer's Disease
Amyotrophic Lateral Sclerosis
Anemia (Aplastic, Cooley's, Hemolytic, Mediterranean or Sickle Cell)
Anxiety
Aortic or Mitral Valve Stenosis
Arteriosclerosis
Arteritis
Asbestosis
Asthma
Bipolar disease
Cancer
Cardiomyopathy
Cerebral Palsy (infantile)
Chronic Obstructive Pulmonary Disease
Cirrhosis of the Liver
Coagulation Defects
Congestive Heart Failure
Cy... 阅读全帖 |
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f******I
发帖数: 769 | 12
is ciclosporin the same as cyclosporine?
for aplastic anemia, assume she is more than 55 years old, treatment would
be anti-thymocyte globulin plus or minus cyclosporine,
or you could try cytoxan,
once you achieve remission then can consider marrow transplant which would
be curative,
if you plan to get transplant later would need to try to minimize
transfusion,
if not able to reach remission the mortality i think is about 60 to 70%
witinin a year,
there is also a considerable risk to progress t |
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f****o
发帖数: 2770 | 13 marrow bipsy sounds scary but it's frquently done for patients with
hematologic problems. you will receive lidocaine to numb the area. it's a
easy procedure with some soreness after it's done.
it can be used to check all kinds of hematologic problems, aplastic anemia,
myelodysplastic syndrome, chronic/acute myeloid/lymphocytic leukemia, etc.
maybe you should see a hematologist |
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l*h
发帖数: 4124 | 14 the main differential would be hypocellular MDS.
it could be quite difficult to distinguish these two in some patients.
basically, in AA, blood stem cells are decreased in number but their
functions are normal; in MDS, the number can be either normal or decreased,
but their functions are abnormal. as a result, in AA, the morphology of
peripheral blood cells is normal; in MDS, some cells have abnormal
morphology and may be destroyed prematurely.
AA usually occurs in children and young adults; MDS... 阅读全帖 |
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l*h
发帖数: 4124 | 15 so on that report, there was no megakaryocytes/thrombocytes.
your newly posted results strengthened my discomfort with the diagnosis of
aplastic anemia. if you look at the myelo and erythro lineages, the general
trend is that the further along the maturing process, the further the values
drop below the lower limits. this indicates defects in stem cells resulting
in blood cells with decreased survival (rate and/or length) instead of just
depletion of stem cells. |
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l*h
发帖数: 4124 | 16 obviously i neither have seen the patient nor have all the information, so
it is difficult for me to give a firm medical opinion. but some of the
results you have shown argue against AA.
some aspects of the treatments for AA and MDS (and related diseases) are
similar, some are different, so there should be enough motive to do a proper
differential diagnosis.
the 11/20 marrow biopsy report implicated AA, but the reporting physician
failed to describe any differential features. the reporting physi... 阅读全帖 |
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g********s
发帖数: 67 | 18 国内一小孩得再生障碍性贫血，想来美国治疗，请问大家有谁知道美国哪个美国医院或
医生是这方面的权威或专家？谢谢！ |
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f****o
发帖数: 2770 | 19 来美国看有钱么
MD Anderson
St Jude
基本上reputable cancer hospital你都可以去问问啊 |
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e********e
发帖数: 435 | 20 是查Parvovirus IgM 还是IgG? parvovirus IgG + 说明你以前得过，这是好事，你不
可能再得而且不可能传给fetus。如果是parvovirus IgM + 说明你最近得的，这就有一
定可能性传给fetus，有可能导致fetal aplastic anemia. |
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g********s
发帖数: 67 | 22 国内朋友小孩得再生障碍性贫血，想来美国治疗，请问大家有谁知道美国哪个美国医院
或医生是这方面的权威？谢谢！ |
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h*****u
发帖数: 97 | 23 根据严重程度，采取不同治疗方法。程度较重的小孩最好做移植。如果需要做移植，我
可以提供一些信息。 |
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d******1
发帖数: 709 | 24 去boston children's hospital （BCH).
全世界也没几个地方比BCH做得好了，在红细胞方面。 |
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g********s
发帖数: 67 | 25 谢谢。可以把信息发到我站内信箱吗？
他们的国内药物治疗不是很理想，估计得试移植。 |
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t***o
发帖数: 160 | 27 老是分不清，选项中有这两个就晕了，有什么区别，显微镜下都是骨髓fat多，细胞少
吗？临床有什么关键词可以区分这两个？谢谢！ |
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t***o
发帖数: 160 | 28 老是分不清，选项中有这两个就晕了，有什么区别，显微镜下都是骨髓fat多，细胞少
吗？临床有什么关键词可以区分这两个？谢谢！ |
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W********r
发帖数: 158 | 31 The first line of treatment for Aplastic anemia is stem cell transplant. If
no suitable donor, first line is ATG and cyclosporin. Shanghai Children's
Hospital is one of the best center to deal with this kind of disease in
China. I will definitely continue treatment there. |
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d***g
发帖数: 9 | 32 很多年轻人到美国都想要申请大学的护士专业，也就是英文所说的Nursing，因为几乎
每个人都说护士可以在美国申请到绿卡，可以赚年薪起薪6万，那为什么有人说简单，
有人说复杂，这其中究竟有什么诀窍呢？
那么下面整个介绍一下在美国做护士的步骤，以及申请绿卡的条件。
这篇文章会介绍几个部分的内容，
包括：
1 申请护士职业移民最基本的条件和优点。
2国内护士专业毕业，人在美国，或人不在美国，如何申请美国大学的护士专业或申请
护士执照考试和如何进行职业规划。
3国内高中毕业，有高中毕业文凭，人在美国，如何申请美国大学的护士专业。
4国内大专或本科毕业（非护士专业），有高中和大学文凭，如何申请美国大学的护士
专业。
5 已经有身份（有绿卡或是美国公民），但是想申请护士专业，如何申请美国大学的护
士专业。
6 通过考试后，取得美国护士执照，通过托福考试后，如何找医院面试谈判，如何找律
师递交移民申请，如何关注职业移民配额，最终申请绿卡。
7 注册护士考试的英文名称和考试内容，那里可以买参考书，网上有哪些资源。
8 申请过程中常见的困难和困扰有那些
9 托福考试的复习与报考准备
10 附录 护士注册... 阅读全帖 |
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